PMID- 8039761
OWN - NLM
STAT- MEDLINE
DCOM- 19940823
LR  - 20151119
IS  - 0390-6078 (Print)
IS  - 0390-6078 (Linking)
VI  - 78
IP  - 6 Suppl 2
DP  - 1993 Nov-Dec
TI  - Erwinia- and E. coli-derived L-asparaginase have similar effects on hemostasis. 
      Pilot study in 10 patients with acute lymphoblastic leukemia.
PG  - 57-60
AB  - BACKGROUND: L-asparaginase (L-ase) affects the synthesis of several hemostatic 
      factors, including the naturally occurring clotting inhibitors antithrombin III, 
      protein C and S, and thromboembolic events are a well-recognized complication of 
      the hypercoagulable state resulting from this treatment. Recently, in addition to 
      the widely used E. Coli-derived L-ase, a new L-ase derived from Erwinia 
      Carotovora has been introduced into clinical studies. This formulation seems to 
      have lesser side-effects, but data on its effects on the hemostatic system are 
      very limited. We report here the hemostatic changes observed in 10 adult patients 
      with acute lymphoblastic leukemia (ALL) treated with Erwinia- or with E. 
      Coli-derived L-ase. METHODS AND RESULTS: The decreases (percentages of basal 
      level) of antithrombin III, protein C and plasminogen (functional assays) were 
      similar in both groups of patients (about 50% of the basal value 6 or 8 days 
      after starting L-ase) and so were the number of instances in which the level of 
      these proteins fell below 70% of normal. On the contrary, the fibrinogen level 
      (PT-derived method) was less severely decreased by Erwinia L-ase (34% of basal 
      value for E. Coli L-ase versus 58% for Erwinia L-ase; P = 0.048) and there were 
      more instances in which the fibrinogen level was less than 100 mg/dL than with E. 
      Coli L-ase (40% versus 16%; P = 0.051). Thrombin-AT-III complexes (ELISA) showed 
      similar pattern during both treatments. Two patients treated with Erwinia L-ase 
      had moderate hyperglycemia, requiring insulin treatment but not L-ase 
      discontinuation. No allergic reaction or pancreatitis was observed. A patient in 
      the Erwinia L-ase-treated group developed deep venous thrombosis on day 7 after 
      the start of L-ase and was treated with subcutaneous heparin (12,500 U x 2/day), 
      with prompt improvement. CONCLUSION: This study shows that the two L-ase 
      formulations have similar effects on hemostasis. Patients treated with Erwinia 
      L-ase may develop thrombotic symptoms, as already reported for E. Coli-L-ase.
FAU - Castaman, G
AU  - Castaman G
AD  - Department of Hematology, San Bortolo Hospital, Vicenza, Italy.
FAU - Rodeghiero, F
AU  - Rodeghiero F
LA  - eng
PT  - Clinical Trial
PT  - Comparative Study
PT  - Journal Article
PT  - Randomized Controlled Trial
PL  - Italy
TA  - Haematologica
JT  - Haematologica
JID - 0417435
RN  - 0 (Bacterial Proteins)
RN  - 0 (Isoenzymes)
RN  - 5J49Q6B70F (Vincristine)
RN  - EC 3.5.1.1 (Asparaginase)
RN  - VB0R961HZT (Prednisone)
RN  - ZRP63D75JW (Idarubicin)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Antineoplastic Combined Chemotherapy Protocols/therapeutic use
MH  - Asparaginase/administration & dosage/adverse effects/*pharmacology
MH  - Bacterial Proteins/administration & dosage/adverse effects/*pharmacology
MH  - Erwinia/*enzymology
MH  - Escherichia coli/*enzymology
MH  - Female
MH  - Hemostasis/*drug effects
MH  - Humans
MH  - Idarubicin/therapeutic use
MH  - Isoenzymes/administration & dosage/pharmacology
MH  - Male
MH  - Middle Aged
MH  - Pilot Projects
MH  - Precursor Cell Lymphoblastic Leukemia-Lymphoma/blood/*drug therapy
MH  - Prednisone/therapeutic use
MH  - Thrombophlebitis/*chemically induced
MH  - Vincristine/therapeutic use
EDAT- 1993/11/01 00:00
MHDA- 1993/11/01 00:01
CRDT- 1993/11/01 00:00
PHST- 1993/11/01 00:00 [pubmed]
PHST- 1993/11/01 00:01 [medline]
PHST- 1993/11/01 00:00 [entrez]
PST - ppublish
SO  - Haematologica. 1993 Nov-Dec;78(6 Suppl 2):57-60.